Student Record Request Form - Cincinnati Public Schools
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1CUSTOMER HELP CENTER INACTIVE RECORDS DEPARTMENT
Student Record Request Form
THIS FORM MUST BE COMPLETED AND ALL FEES PAID PRIOR TO THE RELEASE OF INFORMATION.
Transcript Request = $5.00 per request
Student Graduation Verification = $2.00 per request
Other Records Information = $2.00 per request
: ____________________________
Date
Your Current Information:
Send OFFICIAL COPIES to:
________________________________________
________________________________________
Name:
First
M.I.
Last
School/Employer Name
________________________________________
________________________________________
Date of Birth
Street/PO Box
________________________________________
________________________________________
Street/Apt #
Office/Department/Suite #
________________________________________
________________________________________
City/State
Zip Code
City/State
Zip Code
________________________________________
________________________________________
Phone Number
Phone Number
Yes
No
Have you, an employer, or a school requested your student records from this office in the last 2 years?
Are you requesting the records be mailed to your address (this copy will be unofficial)?
Yes
No
Other names under which you may have attended: _____________________________________________________________
: ______________________________________________________________________________
Last High School Attended
: __________________________________________________________________________
Mother/Father/Guardian’s Name
: ___________
GRADUATE:
Yes
No
YEAR OF GRADUATION
:
: ____________
NON-GRADUATE
Yes
No
LAST YEAR OF ATTENDANCE
: ____________________________________________________
Signature (required)
PLEASE ALLOW 4-6 WEEKS FOR PROCESSING
*NO PERSONAL CHECKS* Cash or money order is accepted. Make money orders payable to Cincinnati Public Schools.
Sign and return along with applicable payment to the address of your high school or location.
If the request is for an INACTIVE RECORD, please send your request, a copy of your State I.D. or Drivers License, and payment to:
Cincinnati Public Schools, Attn: Inactive Records, P.O. Box 5381, Cincinnati, Ohio 45201-5381
Please call: (513) 363-0438 with any questions or concerns
FOR OFFICIAL USE ONLY
□
□
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Request for:
Transcript
Student Graduation Verification
Other Record Information
DATE SHIPPED OUT STAMP HERE
BOX NUMBER OR PERSON
State ID/Driver’s License #: __________________
BOX NUMBER OR PERSON
$ __________
RECEIPT # ______________
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